Ritu Raj Upreti1, Ashwini Budrukkar2, Udita Upreti3, Shagun Misra2, Tabassum Wadasadawala4, Satish Kohle3, Deepak D Deshpande3. 1. Department of Medical Physics, Tata Memorial Hospital, TMC, Parel, Mumbai, India. Electronic address: rituraaj123@yahoo.com. 2. Department of Radiation Oncology, Tata Memorial Hospital, TMC, Parel, Mumbai, India. 3. Department of Medical Physics, Tata Memorial Hospital, TMC, Parel, Mumbai, India. 4. Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, TMC, Kharghar, Navi Mumbai, India.
Abstract
PURPOSE: To investigate the change of clinical target volume (CTV) and its dosimetric impact during the course of accelerated partial breast irradiation (APBI) using intraoperative multicatheter interstitial brachytherapy after open cavity surgery. METHODS AND MATERIALS: Twenty-two patients of APBI with intraoperative placement of catheters underwent computed tomography scans for the treatment planning before the first (CT1) and the last (CT2) treatment fraction. Delineation of lumpectomy cavity and CTV was done consistently on both CT data sets by one of the coauthors. Optimum plan (PCT1) was made on CT1. PCT1 was manually reproduced in CT2 which yielded plan PCT2. Plans were compared using coverage index (CI), dose homogeneity index (DHI), external volume index (EI), overdose volume index (OI) and conformal index (COIN). RESULTS: The mean ± SD volume of lumpectomy cavity and CTV was 78.5 ± 40.7 cm3, 156.4 ± 69.0 cm3 for PCT1, and 84.7 ± 50.1 cm3 (p = 0.11), 165.7 ± 82.8 cm3 (p = 0.15) for PCT2, respectively. CTV volume increase by ≥ 10% was observed in 9 cases however decrease of ≥10% was observed in 5 cases. Mean (SD) of absolute pairwise difference in CTV volume was found to be 13.2 (6.7) %. For cases with increase in CTV volume, significant (p < 0.05) decrease of 8.4%, 12.2%, and 5.5% was observed in CI, EI, and COIN of CTV respectively. However for cases with shrinkage of CTV, significant (p = 0.004) increase of 45% in EI was observed, whereas COIN reduced significantly (p = 0.001) by 13.5%. Overall 22 cases showed significant decrease of 5.8% and 8.1% in mean CI and COIN, respectively. CONCLUSIONS: The change of CTV during the course of APBI using intraoperative multicatheter interstitial brachytherapy after open cavity surgery was found patient specific and showed a significant impact on coverage and conformity.
PURPOSE: To investigate the change of clinical target volume (CTV) and its dosimetric impact during the course of accelerated partial breast irradiation (APBI) using intraoperative multicatheter interstitial brachytherapy after open cavity surgery. METHODS AND MATERIALS: Twenty-two patients of APBI with intraoperative placement of catheters underwent computed tomography scans for the treatment planning before the first (CT1) and the last (CT2) treatment fraction. Delineation of lumpectomy cavity and CTV was done consistently on both CT data sets by one of the coauthors. Optimum plan (PCT1) was made on CT1. PCT1 was manually reproduced in CT2 which yielded plan PCT2. Plans were compared using coverage index (CI), dose homogeneity index (DHI), external volume index (EI), overdose volume index (OI) and conformal index (COIN). RESULTS: The mean ± SD volume of lumpectomy cavity and CTV was 78.5 ± 40.7 cm3, 156.4 ± 69.0 cm3 for PCT1, and 84.7 ± 50.1 cm3 (p = 0.11), 165.7 ± 82.8 cm3 (p = 0.15) for PCT2, respectively. CTV volume increase by ≥ 10% was observed in 9 cases however decrease of ≥10% was observed in 5 cases. Mean (SD) of absolute pairwise difference in CTV volume was found to be 13.2 (6.7) %. For cases with increase in CTV volume, significant (p < 0.05) decrease of 8.4%, 12.2%, and 5.5% was observed in CI, EI, and COIN of CTV respectively. However for cases with shrinkage of CTV, significant (p = 0.004) increase of 45% in EI was observed, whereas COIN reduced significantly (p = 0.001) by 13.5%. Overall 22 cases showed significant decrease of 5.8% and 8.1% in mean CI and COIN, respectively. CONCLUSIONS: The change of CTV during the course of APBI using intraoperative multicatheter interstitial brachytherapy after open cavity surgery was found patient specific and showed a significant impact on coverage and conformity.
Authors: Javier Anchuelo Latorre; Piedad Galdós; Lucía Alonso Buznego; Ana García Blanco; Juan Cardenal; María Ferri; Iván Díaz de Cerio; Elisabet Arrojo; Nicolás Sierrasesúmaga; Mónica González Noriega; Ana De Juan Ferré; Rosa Fabregat; Samuel Ruíz; Pedro J Prada Journal: J Contemp Brachytherapy Date: 2018-02-28